Chapter 12: Creating the Faculty Health and Well-being Program

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Chapter 12: Creating the Faculty Health and Well-being Program

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Ms. Yadiny recounts the story of how the Faculty Health and Well-being Program was established. She tells the story of the suicide of plastic surgeon, Steve Kroll, in 2001. She notes that when the institution did nothing to address this event, a group of individuals approached then-president John Mendelsohn about doing something for the faculty. This group included: Walter Bayle, MD; Warren Holleman, PhD; Ellen Gritz, PhD; Janis Apted, MLS. This group formed a committee and they set in place a response plan for addressing trauma. Ms. Yadiny next recounts how this initiative evolved into a program. She mentions groundbreaking work the Ellen Gritz and Warren Holleman did on burnout. [The recorder is paused] Ms. Yadiny then talks about several initiatives in Faculty Development. First she talks about Dr. Walter Bayle's use of Interpersonal Communication and Relationship Enhancement to teach communication and leadership. She then talks about Faculty Development's sponsorship of the Houston production of the play, "Wit." Focus groups with clinical faculty related to this production were audio taped and used to produce of the video, "On Being an Oncologist."

Identifier

YadinyJA_02_20160301_C12

Publication Date

3-1-2016

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; MD Anderson History; MD Anderson Culture; Working Environment; Discovery and Success; Building/Transforming the Institution; Multi-disciplinary Approaches; Critical Perspectives on MD Anderson; Offering Care, Compassion, Help; Professional Practice; The Professional at Work

Transcript

Tacey Ann Rosolowski, PhD:

Now, right after, so in 2002, you basically were—I don’t know if it was a promotion or a change of name or what it ended up being. You went from being director of the faculty development program to the executive director of faculty development. Tell me about that shift and what it actually meant to your scope of responsibility and your goals.

Janis Apted Yadiny:

Well, when you move up to executive director, you’ve got more visibility. It was a recognition that we were on the right track with the way we were developing the team. We weren’t a big team, in 2004, I guess there were five of us, about five of us, but we were successful at what we were doing to the point where, when we asked for more staff, we were able to get more staff. We got, I guess we got Walter Baile [oral history interview], he was section head of Psychiatry, and he really wanted to move into faculty development, so Dr. Burke moved him in and gave him two staff. That, I think was 2006 or 2007. We were running the Faculty Health program with a committee. We were doing all the programming, setting up all the programming, and that committee was run by Ellen Gritz primarily, and Kathleen Sazama, when she was here, and then Kathleen left and Ellen took over. Again, we were successful enough at showing that what we were doing in that program was substantial, so we were able to put in a director, we got a director with a PhD and she came in.

Tacey Ann Rosolowski, PhD:

How did you document those things, you know how did you make the successful case?

Janis Apted Yadiny:

Well, we wrote reports. I’m trying to remember how we made that case with Ellen. We certainly went to the leadership and—that’s a good question, it’s hard to remember. We went to the leadership and asked for a director of Faculty Health and one assistant, because we felt there was enough work there, that a person could not only set up programming, but work with the chairs on stress and burnout issues, and do some research and do some publishing in the whole area of stress and burnout in academic medicine. We made that pitch to, it would have been at that time, probably Margaret Kripke, and she accepted it and got us the position. So, Faculty Health ran under me and Ellen Gritz for a while, in tandem, and then it moved under Faculty Health—Faculty Health moved totally under faculty development, I think around 2008, maybe 2007, 2008, and as it got more experience, then the director, Thelma Jean Goodrich, left, and we brought in Warren Holleman, that was a really critical hire and a difficult hire.

Tacey Ann Rosolowski, PhD:

Why is that?

Janis Apted Yadiny:

Because we had another candidate, Ella [Speed?], I think her name was, from UTMB, who was an M.D., and she had an idea of how things should be done. Warren Holleman was over at Baylor, had worked there for 20 years, and the committee was kind of split on who should do it. I fought hard for Warren Holleman, I felt he was the right one to come in, because he’d had a lot of programming experience at Baylor, but he had program experience. He’d set up the whole Compassion and the Healing Arts program, and I felt like—he also had a PhD in religious studies, from Rice, he was a trained family therapist. I felt like he had a bigger view of things than Alice did, as an M.D., and he would bring different skills and a different point of view to the table, and I think he’s been, I know he’s been tremendously successful, that certainly has been true. He had his own struggles adapting to the MD Anderson culture and I thought we were going to lose him within two years.

Tacey Ann Rosolowski, PhD:

Oh really?

Janis Apted Yadiny:

Yeah, because he came in, probably 2009 he came in, just as we hit that financial crisis, 2008, 2009, he came in and he confronted the MD Anderson way of doing things. One day he found out that the budget he had, had been vacuumed up, right, and it wasn’t there anymore, and neither was mine, you know in the middle of the year, like March or April, they just took the money that they could find anywhere in the institution, to bolster the financial side of the house, when we hit this economic difficulty, and he was shocked. It hit him personally, as so unethical, that he’d never experienced anything like that, whereas I was kind of blasé about it in a sense, because I’d seen it happen before. And so I really, I think I shocked him, my attitude was like yeah, it will all turn out all right in the end. And then he had some—he had a hard time adapting. He had a struggle adapting to the culture that we talked about earlier and on, the kind of tough, wild west culture, this is the way we do it here, get used to it. He was out of a medical school that was a little more contained, I think, than MD Anderson, but he’s been incredibly successful. One of the things that challenged Warren, which was interesting for me to see, is he’s very sensitive. So he just was a lightning rod. Well, not a lightning rod, what would you say? He absorbed a lot of the complaining and negativity. People came to him because he was a sympathetic listener, so he filled up with the negative stories and the stress. He was an attractor for that and he got really tired and worn out. I could see it happening to him. We had conversations where you know, there are a lot of people who are suffering here, faculty, but there are a lot who aren’t, who are quite happy with MD Anderson the way it is, so you just can’t listen to one side.

Tacey Ann Rosolowski, PhD:

Yeah, it’s interesting. I can’t remember the exact term, but it’s something like sympathetic traumatization [vicarious traumatization], I can’t remember the term, but it’s basically that, I mean if the person is participating and witnessing or hearing stories of others who are suffering, they do take on some of it and they need support in dealing with that.

Janis Apted Yadiny:

Well, yeah, and I feel like we’ve not done a really good job with our clinical staff, in helping them deal with that, because the clinical staff, think of all the death and dying that goes on at MD Anderson all the time and yet, there are no decompression groups or support groups around that.

Tacey Ann Rosolowski, PhD:

Right. Conversations about how to handle things in a practical sense, so process the emotion that comes from it.

Janis Apted Yadiny:

Right, right, exactly, exactly. I think I mentioned last time, when I talked to Dr. Mendelsohn about it one day, I said this is our own Afghanistan here, it’s like a battlefield over there, and we need to go over and give out some hugs. Really.

Tacey Ann Rosolowski, PhD:

Now, I’m sorry, I missed the year that Faculty Health was established, Faculty Health and Well-being. I’m just curious about the timing.

Janis Apted Yadiny:

Two-thousand and one, the committee was established, because Steve Kroll committed suicide, one of the plastic surgeons, committed suicide.

Tacey Ann Rosolowski, PhD:

His last name again?

Janis Apted Yadiny:

Kroll, K-R-O-L-L. He committed suicide in his shower, on a Sunday afternoon, at home, and his 16 year-old son found him. So there was a lot of investigation then, about was there a suicide note? Evidently, there was some kind of note. What was happening at MD Anderson, was it work pressure? And I don’t know, frankly, the whole story, because I’ve never had access to it. There was a note, the wife did come here, there was some pressure at work, but a week before he did this, Walter Baile, a psychiatrist, had lunch with him and didn’t pick up anything. He was in great—but that’s what suicide people can look like, great.

Tacey Ann Rosolowski, PhD:

Good coverers.

Janis Apted Yadiny:

Like nothing is going on. He was fine. There were some pressures having to do with his department and something that was going on there, and maybe the chair, and there was some talk of anti-Semitism that he felt, but I don’t know, I’ve only heard snippets of stuff. When that happened, nobody talked about it. There was no talk to the faculty or even the department my think, so Walter Baile, Ellen Gritz, and George Thomas, went to John Mendelsohn and said this is a problem, we need to form a committee. We would like to form a committee that deals with faculty health issues, well-being and blah-blah-blah, and he said fine, I’d be delighted for you to do that. There was no procedure for how the executive team should handle an issue like this, you know if a faculty member commits suicide or is terminally ill or is killed in an accident or whatever. So when the team came together, they put me on it, and they started talking about what they were going to do, and there was a three-prong thing. I can’t remember all the prongs. Oh, one was programmatic, we’re going to offer program and training. One was, they were going to have a policy around what to do when trauma occurs or when these things occur, and so they did that and they put it into effect and they presented it to the management committee and it was accepted and so on. There was a third thing and I can’t remember what the third thing was, Tacey.

Tacey Ann Rosolowski, PhD:

That’s okay.

Janis Apted Yadiny:

I don’t remember. But in any case, it was very useful policy because then, the next tragedy that occurred was when Michael Keeling was killed in a car accident. He was a very popular chair out of Smithfield, and he was killed around Christmas time. DuBois was here by then, it wasn’t Margaret Kripke, but the executive team went over and dealt with the issue over there, talked to the staff and so on. So they had a way of responding. Now we have Georgia and her exec EAP team, they go to the departments where there are problems and they have sessions with the staff and faculty, so it allows them to grieve and come to grips with these things, these shocking events. That came out of that committee, that whole process, and then as we went on and we did programming for them, we realized, the programming was getting extensive and the needs were great, so that’s why we put in a director position, we requested a director position. One of the things we did, Ellen and I, this was around 2010, I guess. No, it would have been 2007 or so, before we had a director, we wanted to do the Maslach Burnout Inventory on all the faculty, and find out just how burned out were they, you know? And so we went and talked to him and Tom Burke [oral history interview], and he listed to us and he said, “Well, the time really isn’t right because we have this all employee survey coming out, so let’s see what we get out of that first.” Our conclusion was—I think Tom did the right thing by the way—not to do the Maslach Burnout Survey, because then, what would you do if you found out that 60 percent were burned out, or 40 percent were officially burned out? What do you do with data like that? You can’t keep it from the faculty, it can contribute to more burnout and blah-blah-blah. Tom didn’t say that, but in looking back, Ellen and I both thought that’s what he was thinking, like what do you do with that data. So we didn’t do a Maslach Burnout Survey.

Tacey Ann Rosolowski, PhD:

He actually spoke, in his interview, about a period of burnout he went through.

Janis Apted Yadiny:

Sure, everybody’s hit it, where you’re just like so tired of it. How do you keep going? But I think Tom made exactly the right decision, and so we carried on with doing what we were doing. Warren has done sort of informal burnout assessments when he goes out and he does presentations and so on, and as I said, he’s sort of absorbed the level of burnout, and then he and Ellen did that research study on stress levels in research chairs, which had never been done, and they got—that was a great article that they did, because it wasn’t out there in the literature. There’s lots on clinicians but not much, if anything, on research scientists, so I was very proud of that work that they did. And then we did Thelma Jean Goodrich, when she came in, she and Tom Cole—this was a mess actually. It worked out all right, but this is off record, let’s take this off record for a minute.

Tacey Ann Rosolowski, PhD:

Okay, I’ll just pause the recorder. [The recorder is paused.]

Tacey Ann Rosolowski, PhD:

Yeah, we’re going again, okay, so we’re back on.

Janis Apted Yadiny:

I don’t know exactly how we got to the point where we decided Warren was the one, because the committee was split 50/50. We had them each in for lunch, each candidate met with the committee for lunch, and Warren was very impressive and we made the decision to hire him. I’ve never looked back in terms of hiring Warren, I think he’s done a brilliant job.

Tacey Ann Rosolowski, PhD:

That’s great, that’s great.

Janis Apted Yadiny:

So that’s how Faculty Health came to be. Then, Walter was developing Interpersonal Communication and Relationship Enhancement program, and doing a lot of workshops and so on around that, and getting to be skilled at doing psychodrama and sociodrama.

Tacey Ann Rosolowski, PhD:

1:1[0:06] What’s all that and how do those apply in this context?

Janis Apted Yadiny:

Well, he uses that in doing communication skills training and he’s become very good at it. It’s not just role playing, it’s actually using the tools of psychodrama, for instance, to get people to—he does a lot of stand behind the chair stuff. What is this person really thinking, this one, what would you—what’s going through his or her head. Faculty participate in this, they are fabulous. If you say okay, get behind the chair and say what this person is really thinking, you’ll have 15 faculty lined up behind you, all of whom will have something different to say, and it’s great, because they get in touch with their feelings about stuff and they get to understand that other people feel like they do, pissed off, or out of control or whatever. So it’s very real, it gets very real, and that’s what you really need to do when you’re having difficult conversations or difficult interactions. It’s the emotions, the amygdala hijacking, that can really cause you to handle situations badly, so he does a lot of training around that area.

Tacey Ann Rosolowski, PhD:

What’s the name of that program again?

Janis Apted Yadiny:

It’s called ICARE, Interpersonal Communication and Relationship Enhancement. It was started by Walter and a physician called Robert Buckman, who was at University of Toronto. Rob Buckman was an amazing guy, who was doing a lot of guy in teaching, communication skills. Walter met him somewhere and they partnered together. We started off working with Rob, he had been—he was on TV in Toronto. He was a skilled writer, he was skilled at TV production and so on, and he was one of the funniest people I’ve ever met. He was a writer for the Beyond the Fringe group in England, so he’s a really funny guy. But he was very interested in doing this communication skills, and they did a program called ICARE, which is online, it’s online modules on communication skills, clinical communication skills, and Rob plays the doctor. They filmed it in Calgary and they had standardized patients play the roles and so on, and it’s been used by people all over the world, because you can get on and do the training and get CME for it. So, they also did with us, a program called On Being an Oncologist, which is fabulous. This was such a fun project. We were bringing in, at that time, Megan Cole. Megan is an actress, and she had done, in 1999, I guess, just when I moved here, she was the lead actress in “Wit,” down at the Alley Theater.

Tacey Ann Rosolowski, PhD:

Oh yeah, oh yeah.

Janis Apted Yadiny:

Right? She played the lead. She got really interested in the discussion sessions after, when we would have our physicians there, because we cosponsored it. We were a sponsor, one of the sponsors of this. So they would have talkback sessions after some of the performances and she, along with the experts they brought in from MD Anderson, the physicians would talk about the patient experience and the feelings the patient goes through and all that kind of stuff that’s part of Wit. So, Walter got involved with Megan, brought Megan in, and Megan and I did the first series of focus groups in 2000 around, how did you learn how to talk about death and dying. We did several of them with clinical faculty. That’s where I found out about the suicide of Steve Kroll, was in one of those focus groups with surgeons, and we must have had 12 surgeons in the room, and 45 minutes or 50 minutes into the discussion one them says well, you know, things happen, like our colleague, Steve Kroll just killed himself. This is Tuesday night, killed himself Sunday afternoon. It took them that long to get to the point of talking about that.

Tacey Ann Rosolowski, PhD:

Wow.

Janis Apted Yadiny:

They were shocked, you know they were stunned. Nobody knew that Steve had any issues. They talked about how, their own culture of being sort of the—being a surgeon is being part of a cowboy culture. You have to go into surgery really confident and sure of yourself, because your biggest fear is you’re going to make a mistake and someone is going to die. You’re going to nick and artery or you’re going to—something’s going to go wrong. We’ve had those mistakes here, we’ve had bleed-outs in the OR, you know, and nobody wants that and it’s a terrifying thing to think of, but they got really real about what it’s like to be a surgeon doing this every single day, the really complex surgeries that go on here, that go on for like ten, twelve, fourteen, sixteen hours. So, Megan and I did those focus groups and we’ve taped, audio taped all the focus groups, and afterwards, in reading the transcripts, I suggested to Megan and Walter we do something with the transcripts, the transcripts were very powerful. So we talked about it and we ended up doing this videotape called On Being an Oncologist, and I’m very proud of this. This was my idea too. Just take the words of the physicians as they’re said. Megan knew William Hurt, the actor, and he volunteered his time and came in for three days.

Tacey Ann Rosolowski, PhD:

Wow.

Janis Apted Yadiny:

And we filmed these scenarios, using the words of our faculty. Rob Buckman was here and helped with it, and it was powerful stuff, but we didn’t know quite what to do with it, you know, we didn’t have any experience with marketing or any of that, so unfortunately, we sort of underutilized it, but I think it’s still on the ICARE website. It’s powerful. When you listen to the faculty talk about what it’s like internally, to deal with people so sick, and sometimes you deal with the same people for 12 or 15 years before they die, you form real friendships. So they talk about what that’s like, you know, what it feels like. It’s a good piece of work. I was very proud of that piece of work that came out. That was part of the early ICARE program.

Tacey Ann Rosolowski, PhD:

And again, what was the year of that? About what year was that made?

Janis Apted Yadiny:

Well, we did the focus groups in 2000. I bet we had that thing done by 2001, 2002, and there was a booklet that went with it, On Being an Oncologist. Yeah.

Tacey Ann Rosolowski, PhD:

It sounds like a wonderful project.

Janis Apted Yadiny:

It is, it was, yeah, it really was.

Chapter 12: Creating the Faculty Health and Well-being Program

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